The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02

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Here is the text we could read:

JV-218

Child's Opinion About the Medicine

You may use this form to tell the judge what you think about the medicine that   
a doctor wants you to take. 

You do not have to use this form if you do not want to. There are other ways to  
tell the judge how you feel. You can:

• 

Talk to the judge at a hearing or write the judge a letter, or

•  Ask your lawyer, social worker, probation officer, or CASA to tell the 

judge how you feel.

You may ask someone you trust to help you read and fill out this form. And 
you may add as many pages as you need. If you add extra pages, please put 
your name and the number of the question you are answering on each extra 
page. 

Clerk stamps date here when form is filed.

Fill in court name and street address:

Superior Court of California, County of

(month)

(day)

(year)

Court fills in case number when form is filed.

Fill in child's name and date of birth:

Child's Name:

Date of Birth:

Case Number:

1 Your name:

Your date of birth:

(first)

(middle)

(last)

Answer these questions about this medicine:

Do you know that a doctor wants you to take a medicine? 

Do you know the name and dose of the medicine the doctor wants you to take?

Have you taken this medicine before?

Do you want more information before you decide if you want to take it?

If yes, what do you want to know?

Did anyone tell you how the medicine is supposed to help you?

Did anyone explain the possible side effects?
If yes, what did they say?

What is your opinion about taking the medicine?

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

Not sure

Not sure

Not sure

Not sure

Not sure

2

3

4

5

6

7

8

9

Judicial Council of California, www.courts.ca.gov 
New July 1, 2016, Optional Form  
Welfare and Institutions Code, § 369.5  
California Rules of Court, rule 5.640

Child's Opinion About the Medicine

JV-218, Page 1 of 3

Child's name:

10

Do you agree to take the medicine?
Explain your answer here, if you want to:

Case Number:

Yes

No

Not sure

Questions about you

11

List any other treatment or therapy you are doing now:

None
Group talk therapy
Cognitive Behavioral Therapy (CBT or practicing behaviors)
Other (list any other treatment here):

Individual talk therapy
Counseling at school

12 What do you like to do for fun?

Family therapy
Art or play therapy

13

What activities would you like to be involved in now?

14 Say anything else about yourself or the medicine that you want the judge to know.

For a 17-Year Old Youth ONLY
If you are under 17, skip to the next question.

15 When you turn 18,

a.  Will you be able to keep the doctor you have now?

b. Will you know how to get this medicine if you want to keep taking it?

Yes

Yes

No

No

Not sure

Not sure

New July 1, 2016

Child's Opinion About the Medicine

JV-218, Page 2 of 3

Child's name:

For a child taking this medicine now
If you are NOT taking this medicine now, skip to the next question.

Case Number:

16 Do you have any side effects from the medicine?

If Yes, check below:

Yes

No

Weight gain

Weight loss

Problems sleeping

Feeling very sleepy

Headache

Nausea 

Constipation

Feel dizzy

Other (list any other side effects here):

17 I you have side effects, did you tell your doctor?

Yes

No

If Yes, your doctor's name:

18 Did someone help you with this form?

Yes

No

If Yes, who?

my social worker

my probation officer

my caregiver

my lawyer

my CASA

Other (explain):

Check here if you are going to add extra pages to this form. And say how many pages: 

Date:

Type or print child's name

Child signs here

Type or print name of other person who helped child fill out form

Helper signs here

New July 1, 2016

Child's Opinion About the Medicine

JV-218, Page 3 of 3

Child's Opinion About the Medicine

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 3
Fields(s): 81
Average fields per page: 27
Reading Level: Grade 5
LIST Grouping(s): Unknown

Use our Rate My PDF tool to learn more. Go beyond the above insights and learn more about this or any pdf form at RateMyPDF.com, includes: counts of difficult words used, passive voice decetion, and suggestions for how to make the form more usable.

Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

topmost_subform_page_specify_tf was topmostSubform[0].Page1[0].OtherSpecify_tf[0] (0.55 conf)
topmost_subform_page_item_yourname_tf was topmostSubform[0].Page1[0].item1yourname_tf[0] (0.40 conf)
topmost_subform_page_court_info_ft was topmostSubform[0].Page1[0].CourtInfo_ft[0] (0.40 conf)
topmost_page_case_number_ft__1 was topmostSubform[0].Page1[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page_item_b_tf was topmostSubform[0].Page1[0].item2DoB_tf[0] (0.36 conf)
topmost_subform_page_item_cb__1 was topmostSubform[0].Page1[0].item3_cb[0] (0.40 conf)
topmost_subform_page_item_cb__2 was topmostSubform[0].Page1[0].item3_cb[1] (0.40 conf)
topmost_subform_page_item_cb__3 was topmostSubform[0].Page1[0].item3_cb[2] (0.40 conf)
topmost_subform_page_item_cb__4 was topmostSubform[0].Page1[0].item4_cb[0] (0.40 conf)
topmost_subform_page_item_cb__5 was topmostSubform[0].Page1[0].item4_cb[1] (0.40 conf)
topmost_subform_page_item_cb__6 was topmostSubform[0].Page1[0].item4_cb[2] (0.40 conf)
topmost_subform_page_item_cb__7 was topmostSubform[0].Page1[0].item5_cb[0] (0.40 conf)
topmost_subform_page_item_cb__8 was topmostSubform[0].Page1[0].item5_cb[1] (0.40 conf)
topmost_subform_page_item_cb__9 was topmostSubform[0].Page1[0].item6_cb[0] (0.40 conf)
topmost_subform_page_item_cb__10 was topmostSubform[0].Page1[0].item6_cb[1] (0.40 conf)
topmost_subform_page_item_cb__11 was topmostSubform[0].Page1[0].item7_cb[0] (0.40 conf)
topmost_subform_page_item_cb__12 was topmostSubform[0].Page1[0].item7_cb[1] (0.40 conf)
topmost_subform_page_item_cb__13 was topmostSubform[0].Page1[0].item7_cb[2] (0.40 conf)
topmost_subform_page_item_cb__14 was topmostSubform[0].Page1[0].item8_cb[0] (0.40 conf)
topmost_subform_page_item_cb__15 was topmostSubform[0].Page1[0].item8_cb[1] (0.40 conf)
topmost_subform_page_item_cb__16 was topmostSubform[0].Page1[0].item8_cb[2] (0.40 conf)
topmost_subform_page_item_ifyes_tf was topmostSubform[0].Page1[0].item8ifyes_tf[0] (0.40 conf)
topmost_subform_page_item_tf__1 was topmostSubform[0].Page1[0].item9_tf[0] (0.40 conf)
topmost_subform_page_item_cb__17 was topmostSubform[0].Page1[0].item5_cb[2] (0.40 conf)
topmost_subform_page_childsname_tf__1 was topmostSubform[0].Page1[0].Childsname_tf[0] (0.38 conf)
topmost_subform_page_b_tf was topmostSubform[0].Page1[0].DoB_tf[0] (0.38 conf)
topmost_subform_page_item_tf__2 was topmostSubform[0].Page3[0].item11Other_tf[0] (0.37 conf)
topmost_subform_page_childsname_tf__2 was topmostSubform[0].Page3[0].Childsname_tf[0] (0.38 conf)
topmost_page_case_number_ft__2 was topmostSubform[0].Page3[0].CaseNumber_ft[0] (0.43 conf)
topmost_subform_page_item_cb__18 was topmostSubform[0].Page3[0].item10Y_cb[0] (0.40 conf)
topmost_subform_page_item_n_cb__1 was topmostSubform[0].Page3[0].item10N_cb[0] (0.40 conf)
topmost_subform_page_item_n_cb__2 was topmostSubform[0].Page3[0].item10NS_cb[0] (0.38 conf)
topmost_subform_page_item_explain_tf was topmostSubform[0].Page3[0].item10explain_tf[0] (0.40 conf)
topmost_subform_page_item_none_cb was topmostSubform[0].Page3[0].item11none_cb[0] (0.40 conf)
topmost_subform_page_item_grouptk_cb was topmostSubform[0].Page3[0].item11grouptk_cb[0] (0.40 conf)
topmost_subform_page_item_indtk_cb was topmostSubform[0].Page3[0].item11indtk_cb[0] (0.40 conf)
topmost_subform_page_item_counscl_cb was topmostSubform[0].Page3[0].item11counscl_cb[0] (0.40 conf)
topmost_subform_page_item_famthpy_cb was topmostSubform[0].Page3[0].item11famthpy_cb[0] (0.40 conf)
topmost_subform_page_item_artply_cb was topmostSubform[0].Page3[0].item11artply_cb[0] (0.40 conf)
topmost_subform_page_item_cbt_cb was topmostSubform[0].Page3[0].item11cbt_cb[0] (0.40 conf)
topmost_subform_page_item_cb__19 was topmostSubform[0].Page3[0].item11other_cb[0] (0.40 conf)
topmost_subform_page_item_cb__20 was topmostSubform[0].Page3[0].item15a_cb[0] (0.40 conf)
topmost_subform_page_item_cb__21 was topmostSubform[0].Page3[0].item15a_cb[1] (0.40 conf)
topmost_subform_page_item_cb__22 was topmostSubform[0].Page3[0].item15a_cb[2] (0.40 conf)
topmost_subform_page_item_b_cb__1 was topmostSubform[0].Page3[0].item15b_cb[0] (0.40 conf)
topmost_subform_page_item_b_cb__2 was topmostSubform[0].Page3[0].item15b_cb[1] (0.40 conf)
topmost_subform_page_item_b_cb__3 was topmostSubform[0].Page3[0].item15b_cb[2] (0.40 conf)
topmost_subform_page_item_tf__3 was topmostSubform[0].Page3[0].item9_tf[0] (0.40 conf)
topmost_subform_page_item_tf__4 was topmostSubform[0].Page3[0].item9_tf[1] (0.40 conf)
topmost_subform_page_item_tf__5 was topmostSubform[0].Page3[0].item9_tf[2] (0.40 conf)
topmost_subform_childsname_tf was topmostSubform[0].#subform[2].Childsname_tf[0] (0.40 conf)
topmost_subform_case_number_ft was topmostSubform[0].#subform[2].CaseNumber_ft[0] (0.36 conf)
topmost_subform_item_n_cb__1 was topmostSubform[0].#subform[2].item16YN_cb[0] (0.38 conf)
topmost_subform_item_n_cb__2 was topmostSubform[0].#subform[2].item16YN_cb[1] (0.38 conf)
topmost_subform_item_wghtgain_cb was topmostSubform[0].#subform[2].item16wghtgain_cb[0] (0.36 conf)
topmost_subform_item_wghtloss_cb was topmostSubform[0].#subform[2].item16wghtloss_cb[0] (0.36 conf)
topmost_subform_item_headache_cb was topmostSubform[0].#subform[2].item16headache_cb[0] (0.36 conf)
topmost_subform_item_constipation_cb was topmostSubform[0].#subform[2].item16constipation_cb[0] (0.36 conf)
topmost_subform_item_probslping_cb was topmostSubform[0].#subform[2].item16probslping_cb[0] (0.36 conf)
topmost_subform_item_feelslpy_cb was topmostSubform[0].#subform[2].item16feelslpy_cb[0] (0.36 conf)
topmost_subform_item_nausea_cb was topmostSubform[0].#subform[2].item16nausea_cb[0] (0.36 conf)
topmost_subform_item_feeldizzy_cb was topmostSubform[0].#subform[2].item16feeldizzy_cb[0] (0.36 conf)
topmost_subform_specify_tf was topmostSubform[0].#subform[2].OtherSpecify_tf[0] (0.38 conf)
topmost_subform_item_cb__1 was topmostSubform[0].#subform[2].item16other_cb[0] (0.36 conf)
topmost_subform_item_n_cb__3 was topmostSubform[0].#subform[2].item17YN_cb[0] (0.38 conf)
topmost_subform_item_n_cb__4 was topmostSubform[0].#subform[2].item17YN_cb[1] (0.38 conf)
topmost_subform__1 was topmostSubform[0].#subform[2].T130[5] (0.40 conf)
topmost_subform_item_n_cb__5 was topmostSubform[0].#subform[2].item18YN_cb[0] (0.38 conf)
topmost_subform_item_n_cb__6 was topmostSubform[0].#subform[2].item18YN_cb[1] (0.38 conf)
topmost_subform_item_w_cb was topmostSubform[0].#subform[2].item18SW_cb[0] (0.30 conf)
topmost_subform_item_p_cb was topmostSubform[0].#subform[2].item18PO_cb[0] (0.36 conf)
topmost_subform_item_caregiver_cb was topmostSubform[0].#subform[2].item18caregiver_cb[0] (0.36 conf)
topmost_subform_item_lawyer_cb was topmostSubform[0].#subform[2].item18lawyer_cb[0] (0.36 conf)
topmost_subform_item_cas_cb was topmostSubform[0].#subform[2].item18CASA_cb[0] (0.49 conf)
topmost_subform_item_cb__2 was topmostSubform[0].#subform[2].item18other_cb[0] (0.36 conf)
topmost_subform_item_tf was topmostSubform[0].#subform[2].item18other_tf[0] (0.36 conf)
topmost_subform_extrapgs_cb was topmostSubform[0].#subform[2].extrapgs_cb[0] (0.36 conf)
topmost_subform_text_field was topmostSubform[0].#subform[2].TextField2[0] (0.33 conf)
topmost_subform__2 was topmostSubform[0].#subform[2].T6[0] (0.40 conf)
topmost_subform_fill_text__1 was topmostSubform[0].#subform[2].FillText136[0] (0.42 conf)
topmost_subform_fill_text__2 was topmostSubform[0].#subform[2].FillText136[1] (0.42 conf)

We've done our best to group similar variables togther to avoid overwhelming the user.

Suggested Screen 0:

topmost_subform_page_specify_tf
topmost_subform_page_item_yourname_tf
topmost_subform_page_court_info_ft
topmost_page_case_number_ft__1
topmost_subform_page_item_b_tf
topmost_subform_page_item_cb__1
topmost_subform_page_item_cb__2
topmost_subform_page_item_cb__3
topmost_subform_page_item_cb__4
topmost_subform_page_item_cb__5
topmost_subform_page_item_cb__6
topmost_subform_page_item_cb__7
topmost_subform_page_item_cb__8
topmost_subform_page_item_cb__9
topmost_subform_page_item_cb__10
topmost_subform_page_item_cb__11
topmost_subform_page_item_cb__12
topmost_subform_page_item_cb__13
topmost_subform_page_item_cb__14
topmost_subform_page_item_cb__15
topmost_subform_page_item_cb__16
topmost_subform_page_item_ifyes_tf
topmost_subform_page_item_tf__1
topmost_subform_page_item_cb__17
topmost_subform_page_childsname_tf__1
topmost_subform_page_b_tf
topmost_subform_page_item_tf__2
topmost_subform_page_childsname_tf__2
topmost_page_case_number_ft__2
topmost_subform_page_item_cb__18
topmost_subform_page_item_n_cb__1
topmost_subform_page_item_n_cb__2
topmost_subform_page_item_explain_tf
topmost_subform_page_item_none_cb
topmost_subform_page_item_grouptk_cb
topmost_subform_page_item_indtk_cb
topmost_subform_page_item_counscl_cb
topmost_subform_page_item_famthpy_cb
topmost_subform_page_item_artply_cb
topmost_subform_page_item_cbt_cb
topmost_subform_page_item_cb__19
topmost_subform_page_item_cb__20
topmost_subform_page_item_cb__21
topmost_subform_page_item_cb__22
topmost_subform_page_item_b_cb__1
topmost_subform_page_item_b_cb__2
topmost_subform_page_item_b_cb__3
topmost_subform_page_item_tf__3
topmost_subform_page_item_tf__4
topmost_subform_page_item_tf__5
topmost_subform_childsname_tf
topmost_subform_case_number_ft
topmost_subform_item_n_cb__1
topmost_subform_item_n_cb__2
topmost_subform_item_wghtgain_cb
topmost_subform_item_wghtloss_cb
topmost_subform_item_headache_cb
topmost_subform_item_constipation_cb
topmost_subform_item_probslping_cb
topmost_subform_item_feelslpy_cb
topmost_subform_item_nausea_cb
topmost_subform_item_feeldizzy_cb
topmost_subform_specify_tf
topmost_subform_item_cb__1
topmost_subform_item_n_cb__3
topmost_subform_item_n_cb__4
topmost_subform__1
topmost_subform_item_n_cb__5
topmost_subform_item_n_cb__6
topmost_subform_item_w_cb
topmost_subform_item_p_cb
topmost_subform_item_caregiver_cb
topmost_subform_item_lawyer_cb
topmost_subform_item_cas_cb
topmost_subform_item_cb__2
topmost_subform_item_tf
topmost_subform_extrapgs_cb
topmost_subform_text_field
topmost_subform__2
topmost_subform_fill_text__1
topmost_subform_fill_text__2

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Child's Opinion About the Medicine

About This Form:

Identified Data Fields:

Create an Interactive Version of this Form:

The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02